Severe Irritant Dermatitis

The above condition of peristomal skin is called irritant dermatitis. The continuous exposure of effluent from the stoma irritates the peristomal skin. As a result, peeling of skin and weeping occurs. The patient has to change ostomy pouch frequently because of oozing of fluid from the irritated area. Ultimately, the cost of stoma care increases and more importantly the quality of life of patient goes down. Patient hesitates to participate in the social activities due to fear of leakage of pouch, feeling of shame. Also, too often changing of pouch takes more energy from patient side and patient becomes frustrated. Therefore, many things should be kept in mind before selecting and applying the pouch for the particular patient with ostomies.  First of all, for ileostomy or jejunostomy we should select the extended wear skin barrier( adheres for long time) because the liquid discharge contain enzymes and  easily irritates the surrounding skin. Along with this extended wear skin barrier, barrier rings or  paste can be applied round the cut edge of barrier to prevent the migration of effluent into the skin. After selecting the skin barrier and pouch ( open ended, two piece), peristomal skin should be cleaned thoroughly and pat dry. Ostomy powder must be sprinkled around irritated skin and remove the excess. The application of  hydrocolloid wafer ( Duoderm CGF) beneath the skin barrier helps to absorb the serous fluid from the skin and promotes the wear time of ostomy pouch. After healing of skin, only skin barrier can be applied.

I have seen so many patients with this problems and the above pictures are taken from the patients of Bir Hospital. Use of ostomy powder and hydrocolloid wafer helped to heal completely. So, I wrote some points to be considered while  caring for  the patients with such problems.

If you see those conditions, please immediately refer to the ostomy nurses.

The barrier ring should be  applied round in this way ( the cut edge of skin barrier).

Stoma Care FAQ

Specially ileostomy or high output stoma

How to change ostomy pouch

This lady is changing ostomy pouch very nicely. It would help all the health care professionals as well as general population too on the steps of changing pouch with descriptions.

What the stoma Clinic Offers at National Hospital and Cancer Research Center, Jawalakhel

Preoperative Services

Counseling:

·         Basic ostomy education and answers to questions such as surgical procedures, living with a stoma, pre- and post-op diets, concerns re: returning to work, etc.

·         Familiarize patients and their families with various types of ostomy appliances and supplies that are available.

·         Assist patients in selecting a reliable pouching system/appliance, keeping their personal needs and choices in mind.

Stoma Site Marking(s):

·         A preoperative assessment of the abdomen is performed to determine the best location for stoma placement (more than one site may be marked).

·         Stoma site marking(s) may be done during an outpatient pre-op visit, in the hospital pre-op holding area, or in a patient’s hospital room.

·         Proper stoma placement helps patients avoid post-op wound and skin complications caused by leakage.

Postoperative Services

Education on Stoma Management:

·         Patients are instructed on self-care, proper hygiene and how to maintain skin health.

·         Along with patients, families and/or caregivers learn proper stoma care to help prevent common problems from occurring.

General WOC Nursing Care:

·         Care coordination and management for patients with a new or existing ostomy, with or without complications.

·         Determine if patient’s current pouching system/appliance is adequate/ reliable and obtain new appliance if it needs to be updated.

·         Assess patient’s clothing and provide recommendations if needed for undergarments, support belts, etc.

·         Arrange for visit(s) by a home health agency prior to patient discharge and work in conjunction with this agency care and staff for a seamless continuum of care.

Problem Solving & Ongoing Support:

·         Provide assistance with pouching system/appliance failures, such as leaks.

·         Refit pouching system/appliance to provide proper seal and optimum comfort as needed.

·         Assist with short-term care and/or long-term management for patients with peristomal skin loss, infections, ulcers, and/or rashes.

·         Ensure that the patient is coping with lifestyle changes, help to alleviate anxieties associated with the ostomy, providing support as needed

Problematic Stomas

Most people are able to live life with a stoma as they did before their surgery. But sometimes problems do arise which can cause concern. Below are some of the most common stoma problems and some hints and tips to help you overcome them.

Ballooning

Ballooning is where gas collects inside the bag causing it to inflate.

Constipation/Diarrhoea

Changes of bowel function resulting in diarrhoea or constipation are common in the normal population - for a colostomate there is no difference, these alterations in bowel function can still occur.

Granulomas

What causes stoma granulomas and how they can be treated

Odour

Odour could mean leakage or the filter may have come into contact with the contents of the bag making the deodoriser ineffective.

Pancaking

This is when the output collects around the stoma and can squeeze between the flange and the skin instead of going into your bag. One of the reasons this happens is because there isn't enough air in the bag and so the output can not tmove down the bag.

Parastomal Hernia

A hernia is a weakness in the wall of the abdomen that allows the contents to bulge out forming a lump or swelling. If the weakness occurs where the stoma is attached to the muscle wall causing a swelling around the stoma, this is called a Parastomal Hernia.

Prolapse

A prolapse is not uncommon and can be found alone or in association with a parastomal hernia.

Rectal Discharge

Many people with a stoma experience discharge from the back passage despite the fact that they have a colostomy.

Rectal Pain

What causes rectal pain?

Sore skin/Leakage

There are many reasons why the skin may become sore, so it is important to know what may be the cause and to know that you can do something to reduce the problem.

Management of frequent leak of ostomy appliance due to uneven skin!!!!!

There is unven skin. The upper part in figure is high but the lower part is depressed that's why the appliances used to leak frequently. 

The adapt barrier ring was applied on the depressed part of peristomal skin and again adapt barrier ring applied round the cut end of flange so that skin becomes even and adhere on to the skin properly. This way of management might be helpful in the same cases of many patients having stoma.

Presentation about ostomy care at Bhaktapur Cancer Hospital

 

 

 

 

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